Outcome among patients with acute renal failure needing continuous renal replacement therapy: A single center study.

Outcome of acute renal failure (ARF) and use of continuous renal replacement therapy (CRRT) have shown a consistently high mortality. (1) Evaluate the short-term patient survival. (2) Evaluate dialysis-free survival.

Phosphorus-enriched hemodialysis during pregnancy: Two case reports.

Successful pregnancy leading to delivery of a viable infant is an uncommon occurrence either in women with established renal disease or in those with renal failure requiring chronic dialytic treatment. The frequency of conception in patients with renal failure has increased, however, and the outcome of such pregnancies has improved over the past 32 years. Current guidelines for dialysis in pregnant women include prolonged dialysis times, generally 20 or more hours per week.

Clinical risk factors associated with bleeding after native kidney biopsy.

Purpose: To determine the effect of various risk factors on postbiopsy bleeding (PBB).

Procedure: A retrospective review of 645 native kidney biopsies carried out from 1981 to 2001 was conducted. Data regarding age, gender, race, prebiopsy blood pressure, history of hypertension, pre- and postbiopsy haemoglobin/haematocrit, serum creatinine and blood urea nitrogen (BUN) were collected.

End-stage renal disease (ESRD)after bone marrow transplantation: poor survival compar ed to other causes of ESRD.

Chronic renal failure after successful bone marrow transplantation (BMT) may diminish the quality of life and may also evolve to end-stage renal disease (ESRD) requiring chronic dialysis. Individual reports suggest poor survival of such patients. We evaluated the survival with ESRD after BMT by the case-control method.

Ureteral stenosis due to recurrent Wegener's granulomatosis after kidney transplantation.

The ureter is an unusual location for lesions of Wegener's granulomatosis (WG). A patient in whom recurrence of WG after kidney transplantation was manifested by obstructive uropathy due to granulomatous vasculitis (WG) at the ureterovesicle anastomosis, as well as nasal and lung involvement, is reported. The occurrence of WG in the ureter in relation to the processes causing ureteral obstruction and the recurrences of WG after kidney transplantation and its treatment are briefly reviewed.

Preeclampsia related to a functioning extrauterine placenta: report of a case and 25-year follow-up.

We report the case of a patient with preeclampsia due to an extrauterine, intra-abdominal pregnancy. After the fetus was delivered, but while the functioning placenta remained in the abdomen, preeclampsia, which was documented by clinical data and a kidney biopsy, persisted until the placenta was removed 99 days postpartum. A kidney biopsy 21 months postpartum was normal.

Clinical outcome of continuous ambulatory peritoneal dialysis predicted by urea and creatinine kinetics.

The effectiveness of urea kinetics (Kt/V, where K is urea clearance, t is treatment time, and V is the volume of distribution for urea) to assess the adequacy of continuous ambulatory peritoneal dialysis (CAPD) and clinical outcome has not been established prospectively, and cross-sectional clinical studies have been inconclusive. A minimum weekly creatinine clearance of 40 to 50 L is recommended, but the adequacy of this dose is unproven. We introduced a simpler approach to creatinine kinetics in the form of an efficacy number (EN) calculated from data obtained in a standardized 4-h dwell exchange.

Determinants of dialyzer reuseability.

The authors observed a wide variability in the number of uses per dialyzer in their hemodialysis patients. In 54 patients who reused their dialyzers, heparin dose (U/kg/min) related directly and white blood cell count related inversely to reuseability. Average reuse was 5.

Role of the clinical laboratory in guiding treatment of Amanita virosa mushroom poisoning: report of two cases.

Historically, mortality after Amanita mushroom ingestion has ranged from 50% to 90%. Prompt diagnosis is imperative, and aggressive therapeutic measures must be instituted quickly to improve the outcome. We report successful treatment of two cases of A.

A method to assess efficacy of CAPD: preliminary results.

Adequacy of dialysis is a primary concern when caring for patients undergoing continuous peritoneal dialysis (CAPD). To determine objectively the efficacy of CAPD, the use of an 'efficacy number' (EN) calculated from the data obtained in a peritoneal equilibration test (PET) for creatinine (cr) is proposed: EN = [cr(D/P) x V24] divided by ACPPD3 Where, cr(D/P) is PET-derived dialysate/plasma ratio for creatinine at 4 hrs; V24 is the volume of exchanges (L) prescribed for 24 hrs; ACPPD is adjusted creatinine production based on daily dialysate creatinine appearance. PET were performed and the EN calculated in two groups of CAPD patients observed over a 10 month period.

Inflow time and recirculation in single-needle hemodialysis.

The recirculation of previously dialyzed blood in the lumen of the single-needle catheter reduces dialysis efficiency and is a drawback of single-needle dialysis. We reasoned that using maneuvers that would augment the volume of blood drawn in during the inflow phase of each dialytic cycle would decrease recirculation. We tested this hypothesis by progressively lengthening the inflow time and measuring the recirculation rate in three patients undergoing single-needle hemodialysis with a single-lumen subclavian hemodialysis catheter during five separate dialyses.

Pneumococcal vaccine immunization of patients with renal impairment.

The immunogenicity of the polyvalent pneumococcal vaccine was studied in renal allograft recipients and dialysis patients. There was no significant overall difference in the antibody response of the allograft recipients compared to control subjects at 1 month following immunization. Chronic hemodialysis patients had significantly lower postvaccination antibody levels for 6 of 12 serotypes.

Successful second kidney transplantation in a patient with focal glomerulosclerosis. A case report.

We report a woman who developed renal failure due to focal glomerulosclerosis (FGS). This disease recurred immediately in a kidney transplant from her brother resulting in removal of that graft. She subsequently received a cadaver kidney transplant, and FGS has not recurred after 24 months.

Neuropathy in end-stage renal disease secondary to primary renal disease and diabetes.

A study was undertaken to critically observe electrophysiologic findings in patients with end-stage renal disease (ESRD) secondary to primary renal disease (PRD) and to compare these with data recorded from patients with ESRD secondary to diabetes mellitus. Motor and sensory nerve conduction velocity studies were performed on 56 patients; 16 parameters were investigated and laboratory data recorded. Our findings reveal that diabetic uremics have more severe peripheral neuropathy electrophysiologically than nondiabetics, indicating that the diabetic component of neuropathy sustains its influence even in the presence of end-stage renal neuropathy.

Mechanisms producing hypoxemia during hemodialysis.

Arterial hypoxemia occurs frequently during hemodialysis. Proposed mechanisms for this phenomenon have included hypoventilation and embolism of granulocyte aggregates. We studied 18 patients with endstage renal failure who required chronic hemodialysis, and measured arterial blood gases, pulmonary gas exchange, and dialyzer gas exchange.

Habitual excessive dietary salt intake and blood pressure levels in renal transplant recipients.

We observed that renal transplant recipients with good graft function (mean serum creatinine level 1.5 mg/dl +/- 0.5 SD, N = 68) had dietary salt intakes (estimated from serial measurements of 24-hour sodium excretion rate) which averaged 43 percent higher than that of a comparable group of healthy subjects.

Rapidly progressive glomerulonephritis superimposed on diabetic glomerulosclerosis. Recognition and treatment.

Two patients with long-standing diabetes mellitus and diabetic retinopathy were evaluated for declining renal function and heavy albuminuria. Initially, diabetic glomerulosclerosis was suspected as the cause of progressive glomerulopathy. However, in both patients the rate of loss of glomerular filtration rate was greater than that usually seen in diabetic glomerulosclerosis, and the urine sediment contained many RBC casts.

Method for detecting a progressive renal disorder superimposed on a preexisting progressive renal disorder.

We describe a patient with declining renal function due to polycystic kidney disease, who then insidiously develops bilateral renal artery stenosis. The major clue which led to the discovery of the bilateral renal artery stenosis was the finding of an unexpected increase in the rate of loss of renal function. This assessment was based on analysis of the slope of a plot of the reciprocal of the patient's serum creatinine concentration vs.

Stability of renal transplant function with alternate-day corticosteroid therapy.

Fifty-three renal transplant recipients with good to excellent renal function, while receiving daily maintenance or near-maintenance doses of azathioprine and methylprednisolone, were gradually converted to alternate-day corticosteroid therapy. Stability of allograft glomerular filtration rate (GFR) in each patient was assessed by calculating the slope of a plot of the reciprocal of the serum creatinine concentration vs time. After conversion to alternate-day therapy, GFR was stable in 80% but deteriorated in 20% of patients.

Acute motor paralytic bladder in renal transplant patients with anogenital herpes infection.

We report on 2 renal transplant patients in whom acute urinary retention developed after anogenital herpes infections. In 1 case a reversible bladder motor and sensory neuropathy occurred secondary to herpes simplex virus infections. In the other case a motor paralytic bladder developed secondary to an anogenital varicella-zoster infection.

Plasma dopamine-beta-hydroxylase in uremia--increase in enzyme activity after renal transplantation.

Plasma dopamine-beta-hydroxylase in uremia. Plasma dopamine-beta-hydroxylase (DBH) activity was found to be low in 26 uremic patients when compared with 56 normal individuals (p less than 0.001).

Motor nerve conduction indicators in uremic neuropathy.

Eighty-four patients with primary end stage renal disease (ESRD) of varying duration and severity were investigated by a single determination of facial nerve latency and determination of motor nerve conduction velocities of the peroneal, median, and ulnar nerves. Electrophysiologic evidence of motor neuropathy was found in 72 patients. In the facial nerve, conduction was abnormal in 82% of the patients; in the peroneal nerve it was abnormal in 68%; in the median nerve it was abnormal in 36%; and in the ulnar nerve it was abnormal in 22%.